The Telegraph today discloses that a private company will become the first to take over an NHS hospital.

The government line is that the hospital is being ‘saved’ because it was going ‘bankrupt’.

Apparently, keeping it under public ownership as new management turn it around is not an option.

In a landmark decision, the running of Hinchingbrooke Hospital in Cambridgeshire will be handed over to Circle, one of Britain’s most prominent health care providers, which operates a John Lewis-style partnership model for its employees.

Although private firms already own and run limited units for the NHS — such as treatment centres which carry out specific operations like hip replacements — none has ever taken over a complete hospital.

Reader comments

As I have said before tory brownshirts hate anything they can’t own. It is more corporate welfare. Right wing businessmen give money to rightwing politicians who in turn give taxpayers money to rightwing businessman. It is the verry essence of fascism.

Our mission as a social enterprise is to run great hospitals dedicated to our patients.By putting doctors and nurses in charge of our hospitals, and making all employees owners, we empower our people to go the extra mile for our patients.

Allowing this kind of social enterprise to run efficient hospitals where the dead hand of the NHS bureaucracy has failed seems eminently sensible to me.

Circle hospitals are divided into separate business units, named clinical circles. Each clinical circle has a lead doctor, nurse and administrator. Each unit has the freedom and authority to take all decisions that impact upon patient care in their unit, and are responsible for their own balance sheet. In this way, power is devolved to the frontline and decisions are taken as close as possible to patients.

Oh, by the way just like to blame every lib dem politician and supporter who defends The coalition. You lying traitorous scum. You rely on the votes of many public service workers who voted for you, on the proviso that you were not,and did not support the tory party.

It’s a bit more complex than I thought. There’s two companies. There’s the partnership, which does the actual work, and that is owned 49 % by the workers. The other 51% provides the capital, and that 51% is owned by a company listed on the stock exchange. Of the shares of that listed company, around 10% seems to be the float, the rest is in big investment funds.

So, can be righteously called a shareholder owned vehicle or an employee mututal: depends on which way you want to look at it.

However, for those wanting more mutuals: this is almost certainly the way you’re going to have to do it. Because the workers don’t have enough capital to actually provide all the capital that a big mutual needs. You’re going to need outside capital from somewhre.

I don’t understand why more people on the left do not view this as a useful experiment. After all none of us know what the best way to provide healthcare is, we do know that some countries use private providers in a public health system (The Netherlands). Surely what matters it that we get the best healthcare possible, so why don’t we watch this to see what happens. You never know, if it appears to work well, private provision of public healthcare might be a policy the left will want to support.

oh, just in case anybody is going to respond that we should not experiment with people’s healthcare, the converse is true: the more important something is, the more important that we acquire knowledge, the more important that we explore potential improvements. Plus, what do you think a drug trial is, if not an experiment with people’s health.

Here come the usual tory butlers to serve their financial backers. Defending privatisation despite there being no mention of it in both tory and lib dem manifesto.

Also fascinating how they tory trolos, who mae such fuss about trade union money backing the labour party have no problems with the financial control of the tory party by a small uneleted and in many cases non tax paying private companies that see democracy as just another produt to own and control.

The Sell off of the Nhs has begun, and will lead once the bricks and mortar have been flogged off to private insurance and health care as just another product that you can or you can’t afford.

As we have seen with gas and electric and water companies once in the private sector,the ability to then sell on to foreign owners is easy. Circle will sell on to Us buyers in time and no doubt make a fortune in doing so. And all because they bought a bunch of lying dishonest politicians.

Circle’s record of producing good results is excellent and, interestingly, they seem able to do so using clinicians and administrators most of whom had a background working in the NHS.

It seems clear from this that it is the structure of the entity for which people work, and the ethos behind it, that is vital to efficiency rather than how the entity is funded or whether it is profit making. Maybe the social enterprise structure is part of this.

The key to being effective is to have motivated staff who believe in what they are doing and this should not be difficult in an area like health service provision, where there is an initial vocational element in the motivation of many employees. Indeed, it is arguable that the achievement of the NHS in managing to demotivate so many of its staff is remarkable!!!!

One of the strengths Circle seems to be bringing is the decentralised structure it is employing and I do think scale is very important. Workers will never feel as if their efforts are valued and of consequence in an organisation that is too big and with a structure that feels remote.

So they succeed by taking well trained Nhs staff? Hardly a ringing endorsement of them. More an endorsement of the Nhs. I guess once they have poached all the well trained Nhs staff,and stolen our Nhs by buying off sleazy, greedy politicians who have never done an honest days work in their lives.

But I repeat, tory brownshirts hate and want to destroy anything they can’t own and control. It is the ownsership society suckers, and very small group of scum want to own everything.

Tory brownshirts do not own the NHS ,Tim Jerk . we the people do. But you have offered us a Freudian slip there b3cause you have revealed the the arrogant mind set of the tory brownshirt politician. They think and believe that they have a divine right to rule and they see state assets as their own private play things.

Thanks for proving and confirming by opions of the mind of the tory scum.

the extreme right political class in this country cant be trusted with any kind of privatisation, in theory if I lived in a more civilised country I wouldnt be so worried about diversification of models but in this country the lunatic american model is what they aspire to in every sphere (it is the one that allows most power to accumulate in as few hands as possible which is what they are paid to make happen)

@2 – Well sure, YOU can afford health insurance. And of course Circle requires NHS-trained people, they couldn’t afford to train their own staff. They get to put their externalities onto the NHS, and skim the profit.

@6 – If it was an ACTUAL cooperative, yes. And even then, not within the NHS or defence or other critical areas.

@9 – I can see the American model, and the Tory push for it.

And drug trials have ethical controls….the Tory party don’t. I don’t accept that argument.

Very good point about the american model. The tory party and their fanatical base are just a subsidiary of The Republican party. Rand ecconomic madness, stitched together with religious moralty. Only for the little people mind.

The tory party is part of the international crime organisation to steal from the majority and give to the few. With remembrance Sunday approaching, all those tories who fort and died to save this country from fascism wasted their time and life. Hitler should of waited 70 years and just voted tory.

Just to cut through the right wing spin on this, this is not a John Lewis model or a social enterprise. 51% of the business is owned by Circle Holdings, a normal company.

18.9% of Circle Holdings is held by Paul Ruddock’s vehicle, Landsdowne UK and another 21.4% by Odey Asset Management. Both Ruddock and Crispin Odey are very substantial Conservative donors. Seems like they’re getting a good return on their investment in the Tory Party. A nice little racket.

These figures are from a Guardian article in the summer, though I noticed they didn’t mention the donor angle this morning.

whether private provision of public health is a good idea or not, we certainly don’t want private provision by firms owned by large Tory donors.

If private providers are going to be involved in public health, we want them to be able to make money by providing the desired combination of quality and cost (i.e. doing a good job of providing healthcare) not by inventing clever wheezes to extract money from the situation (sale and leasebacks perhaps) or by discovering any other lever to extract rents (perhaps exploiting some badly written contract to bend the NHS over a barrel) – i.e. we want the terms on which private providers are involved to be very carefully monitored. So we don’t want cushy deal stitched up between donor and party – that stinks to high heaven.

The forgoing should be something both left and right agree on.

If you are a left winger who believes state delivery is best, you ought to want the state sector to be as efficient and squeaky clean as possible, if you are right winger who believes private provision is best, you ought to want it to be above board and competitive, not a vehicle for enriching the well connected few. So those who like the idea of private provision ought – on the face of it at least – to be appalled by the links between Circle and the Tory party.

The two companies are in fact investment managers. They’re investing other people’s money, just like pension funds do.

It’s not actually Ruddick and Odey investing: it’s the funds they run. Which will contain some of their personal money, yes, but which are largely the money of other people, the investors in the funds.

Luis: I’ll be appalled when (a) people concerned can put some absolute figures on the beneficial interest of the parties involved (18.9% is all well and good, but this is of the order of £20mn, and Ruddock doesn’t own all of Lansdowne UK) and (b) when actual, deliberate attempts to suborn the bidding process are shown.

Until then, this kind of thing is just throwing mud and hoping it will stick. Unless you want Tory party donors to withdraw from any sort of involvement in the UK at all, which would carry its own significant problems.

What do you think they are making political donations for, then? Come on, I thought you were all over the idea that politicians get bought by people out to feather their own beds. These guys do well personally if the investment fund they run does well, it’s not just about direct interest. I think on this one you’d do better than join in the condemnation, I know it’s not easy for you just to agree with something Sunny writes.

Man who donates to Tories owns part of fund manager, one fund within that fund manager owns small part of small company which owns 51% of worker’s mutual which delivers health care…..not sure I see it in quite the same light really.

32 the old union red herring. Prior to the unions the elite waged a permanent class war on the people. The unions offered the little people a chance to pool their meagre resources to fight the elites.

Unions are made up of millions of tax paying uk residents and every penny has to be declared,and accounted for. All unions have to d3clare what money they give any political party. Unlike the tory donor. Many tory donos pay no tax here. Push their money through third party orgainsations to avoid revealing their identity. The tory party is funded by a very small group of global elites who buy demand their agenda be pushed by their political puppets, while pretending to be non political.

we are not talking about “playing any role in public affairs” we are talking about having an interest in a business that wants to run hospitals and giving money to the political party involved in giving out contracts to run hospitals, then getting awarded said contract.

do yourselves a favour, enough with the equivocation and whataboutary, it’s very simple, take a deep breath and say this stinks

Luis: you’re still not putting numbers on this. Fund managers often own shares in BAe Systems. (Not a popular example around here, I’m sure, but it’s the one which springs to mind.) BAe has this habit of getting government contracts. If the fund managers are Tory donors, that doesn’t automatically make the contract corrupt: you need to show substantial financial interest. A mere link is insufficient.

you’re right, I should check the numbers. Perhaps the donations are desultory.

otoh, if entities that owned as much of BAE as this pair own (or rather the fund managers they own) own of Circle, and BAE was awarded a contract as significant for it as this contract is for Circle, wouldn’t you be concerned about that?

I’d like to know more about Circle too .. these shareholders may only own 50% of Circle, but if they are putting up all the capital do they receive 100% of the returns on capital? Are partners effectively receiving dividends in place of salaries, so that really what we are looking at is more like a conventional private firm whose senior workers get profit share style compensation?

Just to check Luis Enrique – wasn’t the tender put out under Labour?
On the one hand, I’m not too keen on a private company making a profit out of the NHS, but that particular bridge was crossed with the PFI system. The key questions are, who owns the hospital – as I understand it the NHS does. The running has been contracted to Circle, who knows, perhaps Circle will do a good job, in which case even if we don’t get more private companies involved, perhaps we should take on board whatever it is they do.

Is it still free at the point of use? Can rich people pay for better treatment? Or is it just providing exactly what the NHS has always provided, but with slightly better management?

I’m willing to experiment, I mean, we all engage with private NHS contractors already in the form of our GPs.

As for Sally, would it kill you to do some analysis rather than your OMG TORY BROWNSHIRTZ schtick, it’s getting quite old.

Crispin Odey gave the Conservatives £50,000 on 28/04/2011. This entitles him to membership of the Leaders Group, “the premier supporter Group of the Conservative Party. Members are invited to join David Cameron and other senior figures from the Conservative Party at dinners, post-PMQ lunches, drinks receptions, election result events and important campaign launches. ”

Odey is a regular donor on this scale – so the suggestion that Odey might seek influence over the political process is fairly well founded. Odey does have a substantial interest in Odey Asset Management – the clue is in the name (he is the 29th richest man in the UK on the back of Odey Asset Management according to the Sunday Times list)

You can go through similar sums with the two partners in Lansdowne

In addition Circle Health (as I’m pleased to say I revealed in Private Eye , and has been picked up since by the Mirror and now Jamie Reed) pay Mark Simmonds MP £50,000 a year – which is a fairly open attempt to influence the political process.

It is also worth noting that Circle are not doing a great job selling operations from the Bath flagship hospital to the NHS- as local Health Authorities already have capacity in their local NHS hospitals, and Circle have resorted to demanding that regulators force the local Health Authorities to give them more work.

It is certainly true that there were big question marks about New Labour’s involvement with private healthcare (I started of the stories about Alan Milburn’s involvement with Bridgepoint Capital, whose company Alliance won a very dubious MRI scanning contract in Private Eye), but what the Tories and their funders are doing here is ramping up that kind of thing.

I’m not 100% sure why Tim W is making this effort on this argument , though, as he obviously started from a degree of confusion and ignorance about who Circle are.

oh it’s being bankrupt is it? well in that case all hospitals are. They are not there to make profit ffs -_-

If it can’t manage itself on the budget given, then expand the budget, or change management.

It’s not long until we get a “sicko” (Documentary on American healthcare) like situation, where a mother went to a hospital with her kid and they told her your insurance don’t cover us and sent her to another hospital, and her kid died on the way.

“otoh, if entities that owned as much of BAE as this pair own (or rather the fund managers they own) own of Circle, and BAE was awarded a contract as significant for it as this contract is for Circle, wouldn’t you be concerned about that?”

Not without more data! (The eternal cry of a mathematician, especially one who, for his sins, is currently teaching statistics.)

Let me put down some purely hypothetical numbers to illustrate why I can’t just declare myself worried without knowing more.

Guy A manages and owns some units in a fund which has taken a stake of 20% of Circle. He owns 50% of the fund, and the fund’s balance sheet shows 20% of its assets are Circle. His fund units represent 75% of his overall wealth. Consequently, you could assign 10% of Circle to Guy A, and 10% of it to his co-investors; Guy A’s effective stake in Circle represents about 7.5% of his overall wealth.

Chap B is a far richer plutocrat. He also manages and owns some units in a different fund. It has taken a stake of 20%, but Chap B only owns about 10% of the units, and those units make up only 20% of his overall wealth. You can only attribute 2% of Circle directly to Chap B, and Circle accounts for a measly 0.4% of Chap B’s overall wealth.

I would be far more worried if it looked like Guy A had exercised undue influence over government than if it had Chap B. I’m not convinced it would be worth Chap B’s time or money. (This is the flip-side of why I might prefer the engagement of Guy A with Circle over Chap B: Chap B probably doesn’t give a monkey’s, personally, whether Circle lives or dies. It matters more for Guy A.)

as I said above, it’s not the individual’s direct ownership, via the units he owns in the fund he manages that matters. He still benefits if the investors in the fund he manages do well, because he will attract more investors and be able to charge higher fees (fees which may well be funnelled into political donations).

let’s not piss about coming up with hypotheticals in which you think the importance might be diminished. OK if the donation turns out to have been peanuts, perhaps the it made little difference in practice. Here’s what matters: we do not want to see companies that bid for contracts awarded by politicians giving money to politicians. End of story.

I am not prepared to take on trust that this is all innocent, I do not believe that as a rule people donate money to politicians and expect nothing in return.

“Odey is a regular donor on this scale – so the suggestion that Odey might seek influence over the political process is fairly well founded.”

He is a rich man so £50k donations to political parties are pocket change for him.

He evidently supports the Tories, he evidently supports a more mixed provision of care in the health service. Hardly surprising he financially supports such organisations as Circle. Perhaps he genuinely thinks this is a good thing for the country.

If he was solely interested in making money he’d be shorting Italian bonds not bothering with complex issues like investments in the health service.

There are easier ways of making money than getting involved with the bureaucracy and political risk involved in taking over the management of failing hospitals.

“we do not want to see companies that bid for contracts awarded by politicians giving money to politicians. End of story.”

What do you mean ‘we’?

Anyway, (a) the companies didn’t donate, individuals closely associated with the companies did — and that is a material difference; and (b) if the individuals don’t have very much to gain (in particular, less to gain than the value of the donations) then it’s very hard to make that concern stand up.

It’s not messing about with hypotheticals to insist that people who have an interest in the outturn of government policies should not be automatically banned from making political donations. After all, taken to the extremes you seem to imply, all private donations from any source would be forbidden. (As a private individual, I would benefit from a change in personal taxation, so should I be banned from donating money to a political party?) It is therefore entirely reasonable to say that I want to see a case to answer before I agree that there is a case to answer; and I would want proper evidence before accusing anyone of suborning the political process.

“I do not believe that as a rule people donate money to politicians and expect nothing in return.”

Okay, so ban all private donations of any sort, from organisations and individuals alike. The only funding of parties to come from the state. What could possibly go wrong? I’m not saying I think it’s entirely hunky-dory and never results in problems, but private donation is the least bad way to fund politics that we’ve yet invented.

Having individuals with interests in private firms bidding for government contracts donating money to the politicians involved in negotiating and awarding those contracts is cause for concern.

Nobody said anything about banning all private donations to political parties. I might support a law banning donations from individuals with a material interest is firms currently bidding for government contracts. Please don’t tell me these guys do not have a material interest in the fate of Circle.

But hey, if it will make you feel better, I shall acknowledge the theoretical possibility that these guys donated the money because they support some Tory policy or other and that it made absolutely no difference to anything.

As it happens, Crispin Odey does have a record of short selling British banks during the financial crisis – his investment in Circle doesn’t mean he isn’t short selling various bonds and shares at the same time. He also likes throwing cash at the political process – as well as funding the Tories as a party, he employed Kwasi Kwarteng MP as an adivser until a few months ago. Odey is also one of the larger funders of the religious and right wing Christian Party – the one run by Reverend Hargreaves, the anti-gay author of Sinnitta’s “So Macho”. So on the whole I think it is a bad thing when he buys influence over the political process and funds NHS privatisation.

Something linke – Labour, who are funded by money collected by nurses and hospital cleaners and porters opposes more NHS privatisation. The Conservatives, who are funded by millionaires who want to invest in NHS privatisation , wants more NHS privatisation .

“Something linke – Labour, who are funded by money collected by nurses and hospital cleaners and porters opposes more NHS privatisation. The Conservatives, who are funded by millionaires who want to invest in NHS privatisation , wants more NHS privatisation .”

To put it crudely:

Labour are funded by public sector unions who oppose all reform and cuts.

Tories are funded by bankers who oppose all new regulation and higher taxes.

“He is a rich man so £50k donations to political parties are pocket change for him.

He evidently supports the Tories, he evidently supports a more mixed provision of care in the health service. Hardly surprising he financially supports such organisations as Circle. Perhaps he genuinely thinks this is a good thing for the country.”

Oh yes he does it out of the goodness of his heart. I doubt he would ever use the NHS so he does it for the same reason all tories get out of bed. To make money and to destroy anything they can’t own.

So we have a situation where we a have company 50% owned by certain employees and 50% owned by a public company in which various investment funds, some of which are managed by companies part-owned by people who have made donations to the Conservative party, have substantial but non-controlling stakes. With 18%, you have as much chance of influencing policy as the cleaners or, indeed, individual investors in the funds that own the shares.

And this is supposed to make me worried about undue influence over the bidding process?

Luis: I recalled on the way home that I owe you a partial apology — I forgot about the Circle donations to Simmonds, which could well be worth looking into. I’m not saying this is a situation with no possibility of dodgy behaviour: only that I don’t start from the assumption that bad faith is written all over anything like this.

Therefore, I do stick by my view that it is quite simplistic to suspect and oppose all direct donations by anyone with any material interest in firms bidding for government contracts. It would make political donations an absolute minefield for any small investor, for a start: Own shares in Capita, or BAe, or a pharmaceutical? Sorry chum, no donations to the governing party for you.

But at the heart of the specific issue, what this seems to boil down to is that you’re unwilling to assume good faith without evidence, and I’m unwilling to assume bad faith without evidence. I don’t think we can really get past that.

“Oh yes he does it out of the goodness of his heart. I doubt he would ever use the NHS so he does it for the same reason all tories get out of bed. To make money and to destroy anything they can’t own.”

Try hating a little less and think more rationally about why people might have different views from you. You might learn something.

You really think the millions of people who vote Tory want to “destroy” everything they can’t own. That’s just silly.

You are evidently very small c conservative. You just can’t appreciate that the status quo can’t be improved. However much others have pointed out that France or Sweden has a different and better way of providing healthcare you just refuse to engage with the arguments and resort to ad hominems against nasty Tories,

No wonder Tony Blair found dealing with statist dinosaurs in the Labour Party.

I wonder why all the Labour lovers aren’t saying that Unions shouldn’t be giving money to the Labour party – they are buying influence just as much as the rich bastards are when they give to the Tory party.

Witness Kate Green MP apologising to the House for not declaring her interests – being bunged some money to ensure legislation went the way the unions wanted.

Once the left start campaigning to stop unions telling Labour what to then they will gain some respect – for now they just sound like loads of kids shouting about the unfairness of being out of power.

Well, given it was Andy Burnham of the last LABOUR government who signed the Hinchingbrooke/Circle contract I think we can clearly say that any Tory donations from Circle shareholders did little to influence the otcome of that tender, surely?

What I do find hypocritical is that many lefties rail against people giving money to the Tory party saying it buys influence, yet at the same time think its perfectly ok for unions to heavily influence parliament through the labour party?

That’s called hypocrisy.

You lot do also know that there are more individual donors to the tory party than labour as well don’t you? Or that over 80% of labour funding comes from the unions? Or that the unions don’t allow their members subs to go to support the party of their choice (or not at all) – that is decided for them by union bosses. Hardly democratic.

“Circle Holdings plc is a Jersey incorporated company and the rights of shareholders may be different from the rights of shareholders in a UK incorporated company. Circle is a subsidiary of Circle Holdings plc”

I love it that Tories equate unions who represent (however imperfectly) milllions of ordinary people and bankers who represent, er, bankers.

No doubt we shall be told that plcs are largely owned by pension funds that are owned by ordinary people, but you’d have to be bonkers if you think ordinary people have any influence whatsoever on big companies.

You complain about the privatisation of public services and then go on to laud the Japanese railway system, which is itself a successful privatised public service.

Step by step shall we children;

I said your ilk have a nasty habit of making international comparisons you know to be false in order to bat for whichever privatisation happens to be the latest one that is going to deliver us to nirvana. To support this I referenced ASI claims in 1987 that privatising British railways would give us a system akin to that of the Japanese, which it hasn’t; it’s given us a system that ‘requires’ twice as much as it ever cost to run BR in subsidies alongside the most expensive tickets in Europe.

To which your sterling response was – “the Japanese system is privatised.”

[81] “I don’t think there is any intrinsic reason why opening up the NHS to privatisation shouldn’t improve health care outcomes” – if only the coalition had the courage of their convictions to say as much.

I think you are on rather thin ice suggesting those market forces that can be applied to activiies like telecommunications can also be applied to one that entails all manner of ethical and moral problems – not least the corupting influence of deciding how big the profit margins should be when it comes to providing what kind of health services should or shouldn’t be available to the public.

Perhaps we should be grateful that you have not resorted to the usual, and rather tedious supermarket analogy?

[84] the papers you cite (as far as I can tell) are about choice patients are given when selecting 1 of 5 NHS hospitals – so how can we compare the standard that will be available once Ali ‘Circle’ Parsa is running the show?

Surely you must have some reservations about basing an entire belief system on 2 small studies of very complex phenomena.

Maybe you came to papers with an entirely open mind and have been persuaded by the arguments made (although personally, I found the language in the Bristol paper close to unintelligible).

Great emphasis is placed on heart attacks but this is probably one of the few times it would be unfair to burden patients with too many choices.
I mean how would that conversation go – should paramedics say, you can go to hospital A which is 20 miles away and provides primary angioplasty, or would you prefer to go to hospital B which is 5 miles away to reeive chemical thrombolysis? Or if the patient was keen on homeopathy perhaps they could be bussed to the nearest cardio-accupuncturist, or chinese herbalist?

[86] Well of course we can’t compare historic data with what may or may not happen in the future in the case of Hinchingbrooke, for the simple reason that it hasn’t happened yet. But I’m not sure where this gets us.

Let’s be clear. Under the governance of the NHS, Hinchingbrooke has been pretty much a disaster in recent years – a massive deficit, insufficient patients, etc – and in consequence was on a downward spiral. The Labour Government, quite rightly in my view, acknowledged a failing situation and sought solutions from as wide a spectrum of health providers as possible.

Circle have stepped up to the plate. Good for them, I say, especially given the problems they will inherit. This is a solution to be applauded, not derided. Yes, you’re right, they may fail. In which case they’ll do no worse than the NHS to date.

@87 – So instead of something sustainable, it’s been handed over to a company for just 10 years so they can ration care and be done before the long-term health damage comes home to roost. This is SO worth doubling the NHS’s costs for!

Certain villages (http://news.bbc.co.uk/1/hi/8618507.stm) have got sick of BT’s refusal to provide the service they demanded and are doing it for themselves. Presumably they’ll have to do the same with kidney transplants or whatever else private providers decide they can’t be bothered with.

Call prices have come down but that’s attributable (to some extent) to OFTEL price controls which were removed 22 years after the fact.

The privatisation of the Japanese Railway system has been a great success.

The nationalisation wasn’t too bad either, until politicians started demanding bullet trains into their prefectures which plunged the whole thing into debt.

Privatisations can be well organised or poorly organised.

They’re either planned and driven by individuals with high levels of self interest or they aren’t.

I don’t think there is any intrinsic reason why opening up the NHS to privatisation shouldn’t improve health care outcomes.

You’ve managed to recursively dismiss your own point there haven’t you. If your claim was true this either wouldn’t be an issue or you’d be suggesting the exact opposite.

Hence let’s give it a trial. As many have said the NHS model is oddly unique and no other progressive social democratic European country has chosen to copy its model preferring a more mixed approach.

And you’ll reimburse the family of anyone who dies or is injured as a result, right? Or will you shrug your shoulders and tell us all how we need to privatise the roads; they do it in Sweden you know.

[87] “Well of course we can’t compare historic data with what may or may not happen in the future in the case of Hinchingbrooke, for the simple reason that it hasn’t happened yet. But I’m not sure where this gets us” – fair enough, but opening the question up a little bit – why won’t Andy release info about the coalition’s own risk assessment of the HSCB?

Government departments refusing to make important information available.
Private providers who are not required to release details of their business plans (because it is commercially sensitive).
And this is just the beginning of the sort of world that will exist in Andy’s post-NHS health environment.

Circle will have the power to ‘hire ‘n’ fire’, that should be more than enough reason for people to be concerned about private companies moving into the NHS. When a private company needs to up the profit margin, what happens? They start on a campaign of ‘restructuring’, which invariably means redundancies, budget cuts, and a particular concern for a hospital, increased workloads taken on by fewer staff members. The American model is the ambition of the tory right, but they won’t simply allow Circle, or any other private provider to sell off the things they get their grubby hands on. What you will see is a gradual downgrading of health services, lowering the value of the physical assets, buildings and equipment, by the deliberate reduction in quality and standards. Once a hospital reaches a point where the only option is to sell the whole thing, lock, stock and barrel, that’s when the American system will make itself availaible as a saviour, with pots of cash to spend. The accountants at BUPA must be coming in their pants at the thought of millions of people being forced to take out PHI, knowing that the only other option is a downgraded, underfunded, understaffed public service. So I imagine the financial sector will be equally orgasmic, designing new health care loan packages for the low income customers. As for the dirt poor who can’t even afford the most basic health insurance, well, they could always offer their broken, diseased bodies for medical trials, the company, sorry, hospital, would provide healthcare free of charge, in exchange for a free hand, testing out new drugs and procedures.Of course I’M JOKING! Aren’t I?

Labour MP Valerie Vaz, who sits on the health select committee, said the revelation should prompt second thoughts by ministers: “It is difficult to comprehend how Circle can maintain a proper standard of healthcare while maximising profit; as a company they would have to make a profit, but that can only come if costs are cut – such as a shorter stay in bed to recover, one less nurse. That must compromise patient care,” she said (same source).

Labour MP Valerie Vaz, who sits on the health select committee, said the revelation should prompt second thoughts by ministers: “It is difficult to comprehend how Circle can maintain a proper standard of healthcare while maximising profit; as a company they would have to make a profit, but that can only come if costs are cut – such as a shorter stay in bed to recover, one less nurse. That must compromise patient care,” she said (same source).

The beginning of the end ……….. ?

This is why politicians should have some real world experience before opening their mouths and looking like idiots. Over the years I have had a more or less professional interest in the costs of transportation. Land transport has been falling in price since the 1950s. Big falls in the 1980s with deregulation and with containerisation. Yet the speed and quality of service has gone up. A lot. Those nice containers explain why companies can offer a better quality of service while charging much less for it. Not really a technological break through as a series of small improvements coming together in the mind of one man determined to push it through. A huge change to the industry.

Technology improves. Competition means companies become more efficient. Prices go down. Services go up. In almost every industry in the world. Except things controlled by the government. Will Circle improve health care? I don’t know. But I wouldn’t bet on them failing to provide a cheaper and better service.

[93] “I wouldn’t bet on them failing to provide a cheaper and better service” – oh, I agree, it will be better for some, especially those be able to afford the better insurance policies which will be the next inevitable stage in the privatisation process.

The cost will be the loss of a health service that was comprehensive and universal, or these features will be watered down to be virtually meaningless.

Personally I think there is a big difference between wigit production and health ethics, but one things for sure, the less well off will soon find themselves as second class citizens once investment bankers are calling the shots

oh, I agree, it will be better for some, especially those be able to afford the better insurance policies which will be the next inevitable stage in the privatisation process.

Suppose it does. Why would this be a bad thing?

The cost will be the loss of a health service that was comprehensive and universal, or these features will be watered down to be virtually meaningless.

I don’t see how the NHS Would cease to be comprehensive and universal. Those who want to pay for more now can do so in limited circumstances. We still have private health insurance for instance. What you mean is that an ideological goal of yours would be compromised, no? Why should that matter?

Personally I think there is a big difference between wigit production and health ethics, but one things for sure, the less well off will soon find themselves as second class citizens once investment bankers are calling the shots

That is hardly for sure. The more the market operates, the better off everyone is. Health ethics? Is this what lets nurses leave patients to starve of die of thirst?

The present system is getting so bad hardly any alternative would be worse. Unless you think it ought to be run for the Staff of course.

[95] “The present system is getting so bad hardly any alternative would be worse” – most of the evidence shows that the NHS with a period of higher investment has improved quite significantly (although it still costs far less than tax payers are coughing up Germany, France, Switzerland and the USA).

The same item reports, “researchers compared GDP spent on health care between 1979 and 2006 in England and Wales to the spend of nine other countries, including Germany, France, Spain, Japan and the US, and concluded that while cancer deaths fell everywhere, England and Wales saw the biggest drop. As one of the authors of the study said: “We do significantly more with proportionally less.” These findings are proof that ministers have wilfully misrepresented the NHS’s record on cancer”.

You say the NHS is the worst, and that investment bankers can be trusted to look after everybody, irrespective of ability – to my mind that suggests you have almost no grasp of reality, presumably because you are so blinded by market ideology?

[98] “You’re using a report showing the NHS as mid-table (fifth out of ten) as evidence that the NHS is a world beater?” – no, I’m using a report to show that the NHS is not quite as bad as some make out, and that those responsible for the current reforms do not seem to understand cancer stats (or more likely do understand them but prefer to tell porkies).

By the way – do you think the vast cumulative difference in spend on health over the last 50 years (comparing the NHS to France, Germany, Switzerland & the USA) has had any bearing on clinical outcomes?

[100] “Hang on a minute. A couple of hours ago you were using a quote that called the NHS a “world leader” – no, this is obviously a case of you reading what you want to read rather than what was actually said.

If you go back to [96] my observation was “most of the evidence shows that the NHS with a period of higher investment has improved quite significantly”.

I then quoted a newspaper headline [96] “The NHS is a world leader in cancer treatment and in delivering fast access to primary care, so why is the Government allowing a private company to take over a hospital?” – which you naughtily attribute this headline me, while failing to comment on Andy’s use of bogus cancer to rationalise privatisation the NHS.

You also fail to comment on the historical under spend (comparing the NHS to France, Germany, Switzerland OR the US) – but that is hardly surprising given that few marketeers ever have anything rational to say on this matter – a problem Neil Warnock could easily grasp contrasting QPR’s level of funding with that of Cit-eh.

Here is a link to the cancer study in the British Journal of Cancer it says “Comparing GDPHE input (gross-domestic-product on health expenditure) with CMR (cancer mortality rates) output showed that relatively the NHS achieved more with proportionately less than other MDC (major developed countries)”http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2011393a.html

You see – less, for more!!
Why don’t you read it – you might learn something?

“CMR (cancer mortality rates) output showed that relatively the NHS achieved more with proportionately less than other MDC (major developed countries)””

That doesn’t show quite what you think it does. It’s not proof that the NHS is more efficient: it’s proof that the NHS doesn’t spend very much.

Think of it this way. There are some cancers that are relatively easy to cure. There are some that are very difficult (and of course those that currently are not curable at all). Any system that spends any money at all will have some success with those easily curable ones. No system will have any success with those incurable ones. And systems that spend more money will have more success with those difficult ones than systems which spend less.

But! The more difficult ones will be the more expensive ones. So, the per unit cost per cancer cured will go up as more mponey is spent on curing cancer: the unit efficiency of curing cancer will go down as you spend more money on curing cancer.

That the NHS has high unit efficiency is simply the counterpart of it not spending very much.

[103] in the hands of Andy the importance of the cancer stats is not a nuanced interpretation of what can , or cannot be attributed to them, but rather their function as a propaganda device to justify his crappy HSCB.

Look, Andy is saying – the NHS is worse than Latvia when it comes to cancer treatment – the NHS may not be the best but there is certainly evidence of significant improvement (from a middle of the road baseline).

Anyway, I have said before that cancer is too crude a term to use since it consists of over 200 different diseases – and of course these 200+ diseases are only a part of the NHS’s overall activity.

Do you have any evidence that the NHS attempts to cure fewer cancer cases than other health systems?

I ask because if the NHS turns away patients one could reasonably conclude its better efficiency is a result of ignoring expensive cases. But the OECD rates the UK as 6 from 100 and 7 from 100 for the richest half and poorest half of patients, where 6 is perfect availability of healthcare and 100 is unavailability of healthcare (note, we have very closely matched figures for the rich and poor half because so much of the rich half use exactly the same service as most of the poor half)

But without any evidence of that your claim is rather churlish. In effect you just said “but since you can’t know absolutely everything about the world – you can’t assess and conclude anything” – which is an interesting philosophy for some one who has opinions on things.

The NHS not deploying herceptin might be indicative (not proof, but perhaps indiciative) of an NHS that attempts to cure fewer cancer patients that other systems – if you could offer an example (as a&e just said) of a health system that offers all cancer treatments no matter how unsuccesful, expensive, and experimental those treatments may be.

That you can’t, because no such healthcare system exists – I’ll ask that instead fobbing off a request for evidence, you try actually finding some on which to form your opinions – instead of seemingly working making up semi-plausible theoretical explanations of things to fit your opinion but with no evidence that your explanation is in anyway near the truth.

The link here looks at women (can’t run men and women together as it pushes over the 12 line limit) under 74 (I took out older women to compensate for the vageries of differing life expectancy across nations).

This second is the same concept for men – and the UK is lowest on the chart – suggesting we fewer men (per 100,000 population) with cancer than the other nations.

The two charts balance quite nicely and make the UK rather average.

Of course without factoring in what treatments the French don’t deploy, or the number of yanks who are told to just go home and die because they can’t pay for their treatment – it is not really indicative of much – but we can rule out number of cases among the population as a particular factor in the seemingly good efficiency of the NHS.

[101] “I then quoted a newspaper headline [96] “The NHS is a world leader in cancer treatment and in delivering fast access to primary care, so why is the Government allowing a private company to take over a hospital?” – which you naughtily attribute this headline me’

I didn’t attribute it to you, I wrote: A couple of hours ago you were using a quote that called the NHS a “world leader”.

And that is what you did. You took the Telegraph’s quote about being a “world leader” and used it without negative comment to justify your position that the whole Hinchingbrooke/Circle issue is unnecessary.

That’s why I asked if you knew that the NHS came fifth from ten and therefore that the quote was misleading – a question you failed to address.

[109] the quote is misleading only if you do not understand the context in which it was made (debunking tory propaganda about Cancer stats in order to reward investment bankers from goldman sachs).

To my mind it merely proves that no tactic is too low so long as it further promotes the privatisation agenda.

I have provided a link to the study, and the findings are there for all to see, and for commentators to interpret as they see fit.
Phrases like ‘world leader’ are probably best left to the likes of the Fail, although in this case it usage suggests that even staunch tory cheer leaders, such as the telegraph feel somewhat exasperated by Andy’s desperate attempts at disinformation.

I can’t help noticing YOU have been rather economical with comments when asked to address questions about chronic funding differentials between the different health systems!

[110] “Er, no, he’s not. Surely there can be no argument about the fact that “the NHS doesn’t offer certain treatments which other countries might or do”?
Equally, of course, the NHS does offer certain treatments which other countries don’t” – so what’s his point, especially given that NICE have approved herceptin?http://www.nice.org.uk/guidance/index.jsp?action=article&o=32318

Tim W is more than capable of defending his case without my interjections. But at the risk of incurring his wrath, it seems to me that his argument is well summarised in his remark that “The more difficult ones will be the more expensive ones. So, the per unit cost per cancer cured will go up as more money is spent on curing cancer: the unit efficiency of curing cancer will go down as you spend more money on curing cancer.”

Let’s put aside the emotive example of cancer treatment, and take headaches as a less contentious condition. Millions of people in the UK get headaches, and mostly they can be cured by aspirin, paracetamol, or other similar and widely available drugs. These treatments are cheap, and they usually work. The result is good clinical outcomes for a relatively trivial cost = high efficiency. Unfortunately there are a relatively small number of people for whom headaches are seriously debilitating, and who don’t respond to conventional remedies. These people need specialised medical attention and possibly pharmaceutical treatments which cost far, far, more than simple aspirin or equivalent. In those cases, the result is good clinical outcomes at high cost = lower efficiency.
So the more we try to eradicate headaches, the more expensive it becomes, and because the increase is exponential, not arithmetic, the overall efficiency (cost against outcome) of treating headaches declines in quite a dramatic fashion.

That’s why spending less – in my example, limiting headache treatment to aspirin – can paradoxically be more efficient than spending more – in my example, addressing much more intractable headache problems. And it’s also why “efficiency” is a dubious yardstick (but that’s my point, not his).

1 – In talking to Tim W I was pointing out the idiocy of some one expressing an ill-informed and entirely made up random posssibility with no evidence to back it – since the obvious response to such idiocy is simply to ask what evidence there is for it – and when none emerges, to point out that rather than make up theories to back up one’s opinion – one should base theories on evidence and thus inform the development of one’s own opinion.

after all – to do otherwise is the epitome of ignorance.

2 – while you say Tm W is big enough to defend his own ill-founded nonsense – I beg to differ. I pointed out the idiocy of one of his “cetirus paribus is that price goes down when supply increases” blandishments that looks sensible enough to the uneducated but is utterly meaningless to those who actually know economics. The follow up was that a very prolific poster ceased to reply. Likewise on this thread the same has happened.

So maybe Tim W is big enough to defend his ill-founded nonsense only when some one doesn’t suitably analyse it and demonstrate the paucity of knowledge on which it is based.

in order to further demonstrate the idiocy of defending Tim W’s made up explanation of a plausible but undemonstrated model is easily found in your own example.

you have not demonstrated that aspirin is more expensive or cheaper in the UK than in equivelent countries with similar causes of similar numbers of headaches. You have also not demonstrated that the UK then cures fewer of the more expensive headaches than other countries (or whether this is because of a choice based on cost, availability of technology, higher prevelance of such headachs or so on.

All you have demonstrated – as Tim W did – is that because human beings can’t possible know everything, and all evidence on which to base opnions is incomplete – that no opinion is more valid than any other, and that, in fact, we waste our times by analysing anything and forming an understanding based on that analysis.

Which is a fine philosophy in and of itself – but an obviously hypocritical one for some one to promote in the pursuit of demonstrating one’s own opinions on any subject at all.

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